EXPLANATORY STATEMENT

 

Select Legislative Instrument 2006 No. 319

 

Issued by the Authority of the Minister for Health and Ageing

 

Health Insurance Act 1973

 

Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (No. 6)

 

Subsection 133(1) of the Health Insurance Act 1973 (the Act) provides that the

Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed, or necessary or convenient to be prescribed for carrying out or giving effect to the Act.

 

The Act provides, in part, for payments of Medicare benefits in respect of professional services rendered to eligible persons. Section 9 of the Act provides that Medicare benefits shall be calculated by reference to the fees for medical services, including diagnostic imaging services, set out in prescribed tables.

 

Subsection 4AA(1) of the Act provides that the regulations may prescribe a table of diagnostic imaging services, the amount of fees applicable in respect of each item and the rules for interpretation of the table. The Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 (the Principal Regulations) prescribe such a table.

The purpose of the Regulations is to amend the Principal Regulations to enable Medicare benefits to be paid for magnetic resonance imaging (MRI) services conducted using specified equipment at Orana Radiology in Dubbo, NSW.

 

The conditions under which Medicare benefits will be paid in respect of the MRI unit specified above will differ from those in respect of the MRI units currently prescribed in the Principal Regulations. The conditions negotiated with Orana Radiology include bulk-billing concessional card holders only. Persons who are not concessional card holders may be charged up to the schedule fee. This will ensure the financial viability of the service.

 

Details of the Regulations are set out in the Attachment.

 

The Act specifies no conditions that need to be met before the power to make the Regulations may be exercised.

 

The Regulations are a legislative instrument for the purposes of the Legislative Instruments Act 2003.

 

The Regulations commence on the day after they are registered on the Federal Register of Legislative Instruments.

 

Consultation: Medicare Benefits Schedule funded MRI services are managed through the 2003-2008 Radiology Quality and Outlays Memorandum of Understanding between the Commonwealth, (as represented by the Department of Health and Ageing) and the radiology profession (as represented by the Royal Australian and New Zealand College of Radiologists and the Australian Diagnostic Imaging Association).

 

Authority: Subsection 133(1) of the Health Insurance Act 1973

ATTACHMENT

 

Details of the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (No. 6)

 

Regulation 1 – Name of Regulations

 

This regulation provides that the title of the Regulations is the Health Insurance (Diagnostic Imaging Services Table) Amendment Regulations 2006 (No. 6).

 

Regulation 2 – Commencement

 

This regulation provides for the Regulations to commence on the day after they are registered on the Federal Register of Legislative Instruments.

 

Regulation 3 – Amendment of the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006

 

This regulation provides that the Health Insurance (Diagnostic Imaging Services Table) Regulations 2006 (the Principal Regulations) are amended as set out in Schedule 1.

 

Schedule 1 – Amendments

 

Item [1]

Item 1, Schedule 1, Part 2, subrule 31(1) will insert reference to new subrule 31(2A), which is inserted by item [2] below.

 

Item [2]

Item 2 will insert into Schedule 1, Part 2, after subrule 31(2) a new subrule 31 (2A) which will include a reference to new paragraph 36(e) of Part 2 of Schedule 1 which is inserted by item [6] below.

 

New subrule 31(2A) will provide that a Medicare benefit will only be payable for an MRI service performed with the specified equipment under the following circumstances:

-         services to patients who are concessional beneficiaries will be bulk-billed; or

-         patients who are not concessional beneficiaries will be charged up to the Medicare Schedule fee for the services provided.

 

Item [3]

For Schedule 1, Part 2, subrule 31(3), the reference to ‘For subrule (2)’ will be replaced by inserting ‘In this rule’ as this subrule will now refer to subrule (2) and subrule (2A).

 

Item [4]

Item 4 will insert a definition of concessional beneficiary into Schedule 1, Part 2,

subrule 31(3).

 

Item [5]

Item 5 will insert a reference to the eligible equipment as inserted by item [7] below into Schedule 1, Part 2, subrule 34(2).

 

Item [6]

Item 6 will make a grammatical change to allow item [7] to be inserted.

 

Item [7]

Item 7 will insert a new paragraph 36(e) into Part 2 of Schedule 1 to the Principal Regulations. This amendment will provide that the new specified piece of equipment will be Medicare eligible if the equipment:

(a)           is located at the place specified in the regulations;

(b)          has a magnet strength of 1.5T; and

(c)           forms part of a comprehensive radiology department at the relevant location that provides, at a minimum, x-ray, computed tomography and ultrasound services; and

(d)          is available for use from 9 am to 5 pm each Monday to Friday (excluding public holidays) for routine services, except for periods reasonably required for necessary maintenance, repairs and upgrades; and

(e)           is available for use at all times for emergency services, except for periods reasonably required for necessary maintenance, repairs and upgrades.